CCOOMMMMUUNNIITTYY CCAARREE

SSEERRVVIICCEESS PPRROOGGRRAAMM ((CCCCSSPP))

Annual Statewide Report

State Fiscal Year 2012

“CCSP helps me to be more independent. I would be in the Nursing Home if the services were not provided to me. The Personal Support aide assists me with my daily living tasks and she provides companionship. Sometimes no one is home to cook and having Home Delivered Meals is very convenient for me. Having the ERS makes me feel more secure knowing that I can receive help by mashing the button.”

Female consumer age 41 receives PSSX, HDM, ERS Dawson, Southwest Georgia AAA

“I am the main caretaker for mother. She has Alzheimer’s. I am sick myself and have had shoulder surgery a few months ago. My sisters and brother all work. We really appreciate the aide services provided through CCSP. We do not want to put mother in the nursing home. We pay for a private sitter to come in when the aide is not here. This helps us a lot. Otherwise I don’t know what would happen to mother. I cannot stand to think she would go to a Nursing Home.” Caregiver daughter age 76 for Female consumer age 98 receives PSS Eatonton, Middle GA AAA

Georgia Department of Human Services Division of Aging Services

CCSP Statewide SFY 2012 Annual Report reflects data through June 2012 Issued December 2012

COMMUNITY CARE SERVICES PROGRAM (CCSP) SFY 2012 TABLE OF CONTENTS COMMUNITY CARE SERVICES PROGRAM (CCSP) CCSP Reporting 1 CCSP Purpose 1 Home and Community-Based Long Term Care Option 1 Aging Trends & Georgia 2 Demonstrating Results: Community Support for Families, Peace of Mind 3 Statewide Collaboration 4 Gateway/Aging & Disability Resource Connection (ADRC): Information, Referral & Access to Services

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Demonstrating Results: Long-Term Care Option, Quality of Life 6 CCSP SAVINGS & EXENDITURES CCSP Program Cost Effectiveness 7 CCSP Program Expenditures 8 CCSP Cost Share by Consumers 8 Demonstrating Results: Consumer Support & Caregiver Relief 9-10 CCSP PROGRAM & CONSUMERS CCSP Consumer Eligibility 11 CCSP Consumer Demographics 11 CCSP Consumers by Age & Gender 12 CCSP Consumers by Race 12 CCSP Consumer Length of Stay in Community & Reasons for Discharge 13 Consumer Satisfaction 14 Demonstrating Results: Consumer Choice, Independence 14 CCSP PROVIDER AGENCIES & SERVICES

CCSP Services Utilization 15 Demonstrating Results: Avoiding Institutionalization 15 CCSP Consumer Utilization of Services 16 CCSP Services Expenditures 16 CCSP Service Provider Agencies 17 Quality Initiatives 17-18 Description of CCSP Services: Client & Caregiver Quotes 19-21

COMMUNITY CARE SERVICES PROGRAM (CCSP) SFY 2012 CCSP Reporting The CCSP Annual Report reflects State Fiscal Year 2012 activities completed by the Georgia Department of Human Services (DHS) Division of Aging Services and other agencies. It is prepared for the following members of the Georgia General Assembly: Speaker of the House of Representatives President of the Senate Chairman of the House Health & Human Services Committee Chairman of the House Human Relations & Aging Committee Chairman of the Senate Health & Human Services Committee CCSP Purpose Through an interagency agreement with the Georgia Department of Community Health (DCH) Division of Medicaid, the Georgia Department of Human Services (DHS) Division of Aging Services (DAS) is responsible for the Elderly & Disabled Waiver day-to-day operation of the CCSP. As the state unit on aging, DAS contracts with the 12 regional Area Agencies on Aging (AAAs) to manage the CCSP and provide consumer case management. Elderly individuals and persons with physical disabilities who qualify for CCSP Medicaid and meet a nursing home level of care, may be eligible for CCSP community-based services support which prevents or delays institutional placement. Consumers can continue to live safe, healthy, independent and self-reliant lives in the community with needed services at a significant cost savings over nursing facility placement. DAS also provides support and direction to Georgia’s Aging Network, including the AAAs, community service provider agencies, and other partners and stakeholders, in strategic long term care matters and priorities. Home & Community-Based Long Term Care Option According to the AARP, “nine in 10 older Americans want to stay in their homes as they age.”6 For 30 years, the CCSP has been a cost-effective community based long term care service program resource for eligible consumers and families. The Medicaid Home and Community-Based Services waiver CCSP program is authorized in Section 1915(c) of the Social Security Act. The federal government through a waiver agreement approves a State to furnish a broad array of home and community-based services, not otherwise determined as medical assistance in the state plan, that assist eligible Medicaid beneficiaries to live in the community and delay or avoid institutionalization. Funded with federal and state dollars, DCH/DMA reimburses provider agencies for CCSP services provided. The Elderly & Disabled Medicaid Waiver CCSP is designed to: • Serve those most in need with a budgeted program • Determine that consumers who are elderly or physically disabled meet the nursing home

level of care eligibility requirement 6 If Baby Boomers Stay in Suburbia Analysts Predict Cultural Shift, Washington Post, Carol Morello, June 28, 2011

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• Offer eligible consumers a community-based, less costly alternative choice to nursing

facility placement • Assure consumer health and safety needs can be met in the community • Provide care coordination to develop a home and community-based services care plan that

meets consumer physical, social, and health needs • Train and monitor qualified Medicaid waiver service providers.

Aging Trends & Georgia People 65 and older represented 13.04% of the population in the year 20101, and will represent approximately 19.3% by the year 20302. “The elderly population in Georgia will increase by 94.5% between 2010 and 2030 versus a total population increase in Georgia of 25.3%.”3 In 2050, the number of Americans aged 65 and older is projected to be 88.5 million4, approximately twice the number in 2010. The December 2010 Georgia Council on Aging (GCOA) Project 2020- Georgia for a Lifetime- Executive Summary Recommendations to Governor report states: “Georgia, like most parts of the country and the world, is experiencing a dramatic shift in its population. While the total population is expected to grow by 46 percent between 2000 and 2030, the older

1 US Census Bureau, 2010 Census, DP-1 - United States: Profile of General Population and Housing Characteristics: 2010 2 Data for 2050 are from the Census 2008 national projections, issued August 14, 2008 http://www.census.gov/population/www/projections/files/nation/download/NP2008_D1.xls). www.aoa.gov/AoARoot/Aging_Statistics/future_growth/docs/By_Age_Total_Population.xls 3 File 2. Interim State Projections of Population for Five-Year Age Groups and Selected Age Groups by Sex: July, 1 2004 to 2030. Source: U.S. Census Bureau, Population Division, Interim State Population Projections, 2005. 4 Current Population Reports, P25-1138 “The Next Four Decades – The Older Population in the United States: 2010 to 2050.”

5 The State of the States in Developmental Disabilities 2011, David Braddock et al, Coleman Institute & Dept. of Psychiatry, Univ. of Colorado, based on Fujiura (1998), p 58, in press 2012 monograph).

adult population will grow by over 140 percent, the ninth highest increase in the nation. This change affects state and local budgets, development patterns, transportation spending, healthcare services, parks and recreation — almost every facet of community life. It also offers Georgia, its cities and counties and the private sector tremendous opportunities and some potential challenges.” Growth projections for Georgia seniors with chronic conditions indicate there will be substantial increase in the need for home and community-based services, as well as a significant impact on future state Medicaid expenditures overall. In 2011, of the estimated 4.90 million persons with Intellectual/ Developmental Disabilities (I/DD) in the U.S, 2.92 million (60%) were being cared for by their families. Of the 2.92 million family caregivers, an estimated .74 million (25%) were aged 60 years or older. An additional 35% were in households of middle-aged caregivers for whom transition issues are near-term considerations.5

As older adults and caregivers age, and consumers with special needs live longer, there is increasing need for consumer services and caregiver support in the home and community. The majority of adults who are older and/or may be disabled are living longer and want to remain at home and age in place. They want to have choices in how and when they receive services. The CCSP is a long term care option that is responsive to these preferences for eligible consumers.

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Demonstrating Results

Community Support for Families “I am blind, my sister was trying to help me until she got sick, my other sister goes back and forth to the hospital; she is worn thin. I am so thankful for CCSP. The aide, the meals and the emergency button help to keep me in my own home.” Female consumer age 90 receives PSS, HDM, ERS Macon, Middle GA AAA “CCSP has been the biggest blessing to our family. My mother is 94 years old and unable to be left alone. All of us children work and have families of our own and are unable to be present the way my mother needs. The aide is fantastic. She is like a member of our family, seeing how she has been with us so long. The agency is great too. Rarely is our aide out, but when she is they notify us before hand and already have a replacement lined up. Our aide knows more about my mother’s health and likes and dislikes than we probably do. We all just thank you for all you do.”

Daughter caregiver age 62 of Female consumer age 94 receives PSSX

Valdosta, Southern GA AAA

“The Community Care Services Program is a God send. My husband and I are elderly and are having an increasingly difficult time taking care of our daughter. If it wasn’t for the help of her aide, we would not be able to keep her in her own home, where she wants to be. The aide helps with everything we can’t do for her. Our daughter has bonded with the aide and looks forward to seeing her every day. The aide provides one on one physical care and social interaction to our daughter that I know she wouldn’t receive at a nursing home and for this, we are truly blessed.”

Mother caregiver age 84 of Female consumer age 64 receives PSSX

Temple, GA Southern Crescent AAA

Peace of Mind “I am so happy that my mom gets the services she gets. Without the aide coming in to bathe her and get her dressed, I don’t know what I would do. My mom is very proud and being her son, I don’t think I would be able to bathe her the way she needs. The meals also help and she is able to put them in the microwave. I do not have to worry about her having something to eat during the day while I am at work trying to make a living to help support my family. Without CCSP, I would have to put her in a NH and I promised my father that I would take care of my mom. I am so glad CCSP is helping me keep my promise.”

Son Caregiver of Female consumer age 71 receives PSSX, HDM

Brunswick, Coastal GA AAA

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Statewide Collaboration Consumers receiving CCSP services may also benefit from the statewide service network and the cooperation and partnership of state and local agencies and private businesses.

Department of Human Services • Division of Aging Services (DHS/DAS) Community Care Services Program Livable Communities Program Integrity Long-Term Care Ombudsman Access to Services Elder Rights Adult Protective Services Area Agencies on Aging (AAAs) CCSP Care Coordinators CCSP Service Provider Agencies Gateway/ADRC (Information, Referral & Assistance) Non-Medicaid services Database of local services/ resources

• Division of Family & Children

Services (DHS/DFCS) Department of Community Health • Division of Medicaid

• Division of Healthcare Facility Regulation (DCH/ HFRD)

Department of Public Health (DPH)

Department of Behavioral Health and Developmental Disabilities (DBHDD)

DHS/DAS has the primary responsibility for the day to day operation of the CCSP program. Coordination of the various entities working together to deliver quality consumer-focused and cost effective services to eligible consumers is the priority of the CCSP. DAS Sections, particularly Adult Protective Services, Program Integrity, and Livable Communities (non-Medicaid community-based services) enhance consumer protection, program and services quality improvement, and, provides community resource availability to consumers. AAAs contract with DHS/DAS to serve as Lead Agencies or regional managers of the CCSP. The 12 AAAs serve as the no wrong door local Gateway/Aging and Disability Resource Connection (ADRC) coordinated system for consumers of all incomes and ages, their families, caregivers, and service providers, to get information on the full range of long term support services. The AAAs manage client service benefit allocations, assuring the CCSP does not exceed budgeted funding. DHS/DFCS determines consumer Medicaid eligibility and cost share for services for those whose income is over the SSI limit. Under federal administration by the Centers for Medicare & Medicaid Services (CMS), Division of Medicaid administers and oversees the Elderly and Disabled waiver program, and is responsible for provider enrollment, reimbursement, and utilization review. DCH/HFRD is the regulatory and licensing entity for CCSP service providers. DPH is the state lead agency in preventing disease, injury and disability; promoting health and well-being; and preparing for and responding to disasters from a health perspective. DBHDD is the state MH and DD authority and provides mental health, developmental disabilities and addictive diseases resources for CCSP consumers in need of services, and also partners with DAS in grant projects and initiatives.

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GATEWAY/Aging & Disability Resource Connection (ADRC) Information, Referral & Access “The intake person was very professional and let me know I was not alone in caring for Mom. Thanks for making me feel like you really wanted to help us. The options you gave were o useful and will make a difference. Keep up the good work.”

Caregiver utilizes Gateway Atlanta, Atlanta Regional Commission

Georgia’s AAA Gateway/Aging & Disability Resource Connections (ADRC) are a no wrong door access point for older adults, individuals with disabilities, families and caregivers. The AAAs Gateway invests in a statewide Information, Referral and Assistance system of services, programs and community resources. In SFY 2012, 54,520 consumers contacted the ADRCs to make informed service choices and decisions about long term services and supports.

Gateway/ ADRCs provide information

and assistance to older adults and individuals with developmental and physical disabilities. Options Counseling is also provided to these individuals when additional information, planning and assistance are needed.

Gateway/ ADRC staff are trained to use the Enhanced Services Program database to search for statewide and local resources based on an individual’s needs

Gateway/ ADRC staff screen individuals using the Determination of Need-Revised assessment to determine the need for services and maintain the waiting lists for CCSP and HCBS services Each Gateway/ADRC has a toll free line for callers, and all AAAs may be reached by calling 1-866-552-4464.

Demonstrating Results Caring for older and/or physically disabled individuals in the community, the CCSP assists families in keeping consumers at home by providing clients the choice to remain in the community and the services they need to remain independent.

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Long Term Care Option “Without CCSP, I don’t know how my family would be able to keep momma at home. The aides have been wonderful and the staff of CCSP is wonderful! Without CCSP, momma would have to be placed in a Nursing Home because all my siblings have health problems and we just can’t take care of mama by ourselves.”

Caregiver daughter of Female consumer age 94 receives PSS

Macon, Middle GA AAA

“I was in the nursing home for five years and then I found out about CCSP and Money Follows the Person. The worst part about being in the NH is that I had to give my dog away to a family member. I got her when she was a puppy, I raised her. The best part of being home is being reunited with her. CCSP gives me the help I need to stay at home. I love my aide because she helps me with all my daily needs, she is my family. I am so thankful for both programs because they have allowed me to return home to my dog. I missed her so terribly in the nursing home. Now I feel happy again. Thank you.”

Female consumer age 37 receives PSS, HDM, ERS

Eastman, Heart of GA Altamaha AAA

Quality of Life “This program has been a God send to me and my mother. I care for my mother in my home. She has first stage Alzheimer’s and is still very feisty and likes what she likes and vice versa. This program makes her life easier because it

allows her to go into the community daily. She so looks forward to go on the bus to the day program and socialize. It allows her to have an aide come in and spend quality time with her who is there just for her and she realizes this. This program has extended my Mom’s life, I believe. Her care coordinator is always available for whatever adjustments or concerns, with sincere concern.” Daughter caregiver of Female consumer age 89 receives PSS and ADH

Dallas, Northwest GA AAA “I have been in the nursing home and I never want to go back there. This help has given me another chance at living by myself. The aides check on me and help me do what I need to do. I have my ERS button, in case I get sick or fall. I don’t want to think about what would happen if I didn’t have CCSP.”

Male consumer age 53 receives PSS, ERS, HDM Waycross, Southern GA AAA

“I couldn’t count the ways CCSP has helped me, made me feel better about myself. The aides take care of me and my husband and handles things we can’t, like housework, personal care, and cooking. CCSP gave us our lives back and made it enjoyable again. You took care of so many little things like getting the fire alarm installed for us. The food is a big help. My husband and I are so thankful and grateful to CCSP.” Female age 60 and male consumer husband age 51

receive PSS and HDM Quitman, Southern GA AAA

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CCSP SAVINGS & EXPENDITURES _____________________________ SFY 2012 “My sister has been receiving CCSP for 28 years. My mother was the caregiver for my sister at the age of 60 and provided care for 21 years until her death. If it had not been for CCSP, it could not have happened this way! Now as the caregiver, it significantly reduces my stress and allows me time to take care of myself. CCSP is a success story and I hope it continues for many, many more decades. We are highly appreciative and consider the CCSP staff very professional, very accommodating and willing to meet our needs!” Sister caregiver, Female consumer age 58 receives PSS, PSSX, and HDM Nashville, Southern GA AAA CCSP Program Cost Effectiveness

Consumers in SFY 2012 who received home and community-based CCSP Medicaid services instead of nursing facility institutionalization

saved GA taxpayers $215,088,075 in Medicaid service benefits expenditures For eligible consumers, the CCSP Medicaid consumer care expenditure option is a cost-effective alternative to nursing facility placement. The Department of Community Health reports that, based on SFY 2012 invoices incurred and paid through October 19, 2012, the average Medicaid cost for NF care in SFY 2012 was $25,854 per person. The average Medicaid service benefits cost per CCSP consumer for the same period was $9,083. 7

$-

$10,000

$20,000

$30,000

SFY 2009 SFY 2010 SFY 2011 SFY 2012

$9,184 $8,569 $9,006 $9,083

$26,232 $28,486 $25,873 $25,854

CCSP NF

Figure 1 In SFY2012, the CCSP Medicaid expenditure to maintain a consumer in the community averaged 35% of the Medicaid expenditure for a CCSP consumer to reside in a nursing facility. This is a $16,771 per consumer taxpayer savings, or an over $215,088,075 million statewide Medicaid savings for 12,825 CCSP clients.

Annual Medicaid Cost Difference Per Consumer Served by CCSP instead of a Nursing Facility

SFY 2009 SFY 2010 SFY 2011 SFY 2012

$17,048 $19,917 $16,867 $16,771 Figure 2

7 CCSP average consumer benefits cost does not include care coordination or administrative costs

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CCSP Program Expenditures In SFY 2012 DCH reimbursed CCSP provider agencies $116,486,614 for consumer services provided. The state administrative cost is just over 1% of the total expenditure for the CCSP. Large health insurance increases in DAS CCSP personnel and CCSP’s share of DAS technology contractor costs resulted in an increase is State Administration costs.

CCSP Program Expenditures SFY 2009 - SFY 2012

Category SFY 2009 SFY 2010 SFY 2011 SFY 2012

Consumer Service Benefits *

$115,707,730

$109,354,458

$111,857,667

$116,486,614

Care Coordination

$22,662,505

$22,883,351

$23,589,962

$23,661,757

State Administration

$1,167,046

$1,238,362

$1,309,954

$1,774,514

TOTAL

$139,537,281

$133,476,171

$136,757,583

$141,922,885

*Consumer service benefits expenditure is based on payment data

Figure 3

Comprehensive care coordination is the foundation of providing consumer-centered care to CCSP consumers. Care coordination assures that enrolled consumers receive cost-effective, appropriate, and coordinated services. The average care coordination cost per consumer in SFY 2012 was $1,845. CCSP Cost Share by Consumers According to their income levels, 67% of consumers pay a portion of the cost of their services known as “Cost Share”. The remainder is paid by Medicaid. Thirty-one (31) % of CCSP consumer costs are fully paid by Medicaid, because the consumer’s income is at or less than the federal Supplemental Security Income (SSI) level. Services for just over 1% of CCSP consumers are provided at no cost to Medicaid because the consumer pays the entire cost of CCSP services.

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Demonstrating Results The Division of Aging Services (DAS), together with other partners, assists older individuals, at-risk adults, persons with disabilities, their families and caregivers to achieve safe, healthy, independent and self-reliant lives.

Consumer Support & Caregiver Relief “This is the best program I have ever found. I get to stay in my home where I want to be. It helps me stay clean, neat, and safe. My aide provides assistance so I can safely go outside. My aide helps me with my bath, household chores, laundry and meal prep. She is good company. CCSP makes every day happier and better. Without CCSP I could not afford this help. My care coordinator is fantastic and great. She adjusts the services to meet my needs and always calls me back. CCSP helps my daughter to have free time to take care of her business and be with her family more often.”

Female consumer age 89 receives PSSX, ERS

Columbus, River Valley AAA

“CCSP was a Godsend to our family. I was the only caretaker for my grandmother. She was very sick and I had to work to pay the bills. CCSP sent in an aide to be there with her until I came home. This made me feel better because someone was there to look after my grandmother. I did not want to put her in a nursing home, and she was able to die at home right where she wanted to be.”

Caregiver grandson of Female consumer age 100 received PSS

Gray, Middle GA AAA

“My stress level has decreased drastically since my parents began receiving help. They both receive PSSX for respite and HDMs each week. I was mentally drained and was exhausted physically as well. CCSP has made a big difference for my parents and me as their caregiver.”

Daughter caregiver of Male age 99 and Female age 80

consumers receive HDM, PSSX Cumming, Legacy Link AAA

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“My wife has been sick for a lot of years. I do the best I can but it was about to get to me before CCSP sent us some help. Now I can take a little time for myself because I know the aide is going to care of my wife, and when the meals come it helps me out so I don’t have to cook all the time.”

Caregiver spouse of Female consumer age 76 receives PSS, HDM

Eatonton, Middle GA AAA

“I am the primary caregiver for my 63 year old husband. The Community Care Services Program has been a great help to my family and me. The services allow me to be able to work during the hours my husband is at ADH. The ERS unit allows me to run errands without worrying about my husband’s safety. The home delivered meals give me some relief while providing my husband with a balanced meal. The CCSP program gives me and my family a peace of mind knowing someone is helping me during the week. I appreciate the program and what it has done for me and my husband.”

Spouse Caregiver of Male consumer age 63 receives ERS, HDM, and ADH

Savannah, Coastal GA AAA

CCSP PROGRAM & CONSUMERS SFY 2012

The CCSP is the program choice for 95% of eligible consumers assessed. Overall, services and care coordination effectively delay or prevent institutionalization of consumers. Community-based services supports the Medicaid eligible consumer’s choice to remain at home or in the community.

“While I worked, I came home every day during my lunch break to bathe my daughter and care for her. My doctor could not believe I was doing that and he recommended me to CCSP. I didn’t know a program like this existed. It allowed me to continue working until I could meet my retirement requirements. CCSP has helped the quality of life for my daughter in allowing her to stay at home instead of being in a nursing facility. The program has saved cost to me because I don’t believe I could afford to pay out of pocket and get this quality of care that I receive through CCSP.”

Mother caregiver age 68 of Female consumer age 49 receives PSSX

Columbus, River Valley AAA

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CCSP Consumer Eligibility Community Care Services Program (CCSP) consumers must meet the same medical, functional, and financial criteria (nursing home level of care, unmet need, Medicaid eligibility) as consumers receiving nursing home care under Medicaid. Area Agencies on Aging Gateway/ADRC information and referral staff conduct telephone interviews to screen consumers for potential eligibility for the CCSP:

• Consumers are prioritized for referral to CCSP based on the results of the telephone assessment. Consumers with highest levels of impairment and greatest unmet need are the first to be referred when funding is available

• A face-to-face Registered Nurse (RN) assessment is conducted to verify eligibility and to determine services to meet the consumer’s needs • The client’s physician certifies that the needs of the consumer may be met by the CCSP and available community resources. The physician approves the Nursing Home Level of Care and care plan, and authorizes delivery of services to the consumer in the community • Eligibility staff at the DFCS determine consumer financial eligibility for Medicaid and, if

applicable, cost share • Care coordination provides ongoing case management, care plan development and review,

and re-evaluation annually or as needed

CCSP Consumer Demographics In SFY 2012, CCSP services supported 12,825 consumers in remaining in the community.

15,830 14,534 13,711 12,986 12,599 12,762 12,421 12,825

0

5,000

10,000

15,000

20,000

2005 2006 2007 2008 2009 2010 2011 2012

Consumers Served by CCSP

Figure 4

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CCSP Consumers by Age & Gender

Age Category # Consumers Percentages*

Consumers 100 years of age or older 111 <1% Consumers 90 years of age or older 1,466 11% Consumers 85 years of age or older 2,875 22% Consumers 75 years of age or older 5,961 46% Consumers 60 years of age or older 9,840 77%

Consumers under 60 years of age 2,984 23%

Gender Female 9,100 71%

Male 3,720 29% *Percentages are rounded Figure 5 CCSP Consumers by Race

In SFY 2012, 51% of CCSP consumers were Caucasian and 43% reported their race as African American.

6,562 5,496

305 211 104 113

1

10

100

1,000

10,000

Caucasian African American Did not disclose Other Asian Not Indicated

Figure 6

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CCSP Consumer Length of Stay in the Community & Reasons for Consumer Discharge “CCSP has been a blessing to me. [The aides] allow me to get the needed help with my daily tasks in order to feel safe in my home.”

Female consumer age 83 receives PSS, ERS Augusta, Central Savannah River AAA

CCSP Average Length of Stay During SFY 2012, CCSP services supported consumers living in the community for nearly four (4) additional years. That means that 12,825 consumers eligible for nursing facility placement retained choice and independence in the community for an average of 47 months – and at significant less cost than in institutional settings. According to the National Nursing Home Survey, the average Length of Stay for patients currently in nursing homes is 2.44 years.8

Average Length of Stay (rounded)

CCSP Nursing Facilities

47 months 29 months Since SFY 2002 there has been a 27% increase in the CCSP consumer length of stay (37 months in SFY 2002). CCSP Reasons for Discharge The need for continuous/higher level of skilled care services results in 26% of those discharged from the CCSP to enter a nursing facility. Caregiver burden was the reason 9% of CCSP discharged clients entered a nursing facility.

Discharged CCSP Consumers – Disposition

# Clients Discharged

% of Total Discharges

Death 1,158 40%

Nursing Facility placement [NF from Home 296; NF from Hospital 469] 765

26% [9% due to caregiver burden]

Moved Out of State/ No Services Provided/ Never received Service/ Unable to Contact/ Other

460 16%

Refused Service/ Requested Termination 297 10%

Does Not Meet Level of Care/ Does Not Meet Eligibility Criteria 62 2%

Other Service or Program/ Over Income/ Financially Ineligible 177 6%

*Percentages are rounded Figure 7

8 http://www.ehow.com/facts_7254573_average-stay-skilled-nursing-facility.html

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Consumer Satisfaction The CCSP uses data for decision making. Results from measures and targets identify program and process opportunities for improvement. In SFY 2012, consumer satisfaction with CCSP waiver services averaged 98%. Consumer response to overall satisfaction with CCSP care coordination was 95%. Ninety-five (95%) percent of consumers report the CCSP care coordinator assisted them in having a better quality of life. Demonstrating Results

Consumer Choice “I was in the nursing home for a few years after I got sick. I wanted to go home so badly but I didn’t have a home to go to anymore. CCSP helped me get my apartment and furniture. My Coordinator comes to visit me to make sure I’m okay. I have aides to take care of me and good food. Some of my friends from the nursing home come to visit. But the best thing of all is that I have my own home again.”

Female consumer age 76 receives PSS, HDM, MFP

Glennville, Heart of GA Altamaha AAA

“The services I receive through CCSP are wonderful. The services allow me to stay here with my son and they are keeping me from having to live in the nursing home. My son and his wife both work and with the aide coming in daily to see about me, they don't have to worry. I was a nurse for many years and I know that it's not easy work, but my aide is excellent, so caring and friendly. I am very thankful for the care I am receiving."

Female consumer age 96 receives PSSX

Hull, Northeast GA AAA

Independence “We wake up thankful every day that we are still together. We think of our aides as members of our family. CCSP helps keep us safe and in our own home where we can continue to give thanks daily.”

Husband and wife consumers ages 85 and 87 receive PSS, HDM

East Dublin, Heart of GA Altamaha AAA

“I really did not fit in at the PCH and just wanted to get back to my home and my dog. The people who deliver meals are more like family. I've been married three times but my home is cleaner now with my aide. You folks are just concerned about my well being.”

Male consumer age 79 receives PSS, ERS, HDM

Lincolnton, Central Savannah River AAA “I really want to stay in my home. My daughter takes care of me but she’s not well and can’t do it by herself. Community Care sends me aides to help get a bath and clean my room and they send meals to help keep up my strength. I really appreciate all the help that makes it possible for me to live at home with my daughter for as long as I can.”

Female consumer age 76 receives PSS, HDM, ERS

Uvalda, Heart of GA Altamaha AAA

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CCSP PROVIDER AGENCIES & SERVICES _ SFY 2012 CCSP Services Utilization

CCSP Medicaid Funds Expended By Service Type & Consumers Served

CCSP

Service

# Consumers

Served*

% Total

Consumers*

$ Funds

Expended

% Total

Funds** Adult Day Health (ADH) 878 7% $5,634,574 5% Alternative Living Services (ALS) - Group Model - Family Mode

1,706 849

13% 6%

$9,363,194 $4,275,991

8% 4%

Consumer Directed PSS option (CDPSS) - Financial Management

400 400

3% 3%

$5,993,586 $231,692

5% <1%

Emergency Response Services (ERS) 5,563 43% $1,189,794 1%

Home Delivered Meals (HDM) 5,880 46% $9,489,698 8%

Home Delivered Services (HDS) Skilled Nursing Services (SNS)

33 76

<1% <1%

$51,487 $135,008

<1% <1%

Out-of-Home Respite Care (OHRC) - Day - Overnight

49 46

<1% <1%

$42,285 $29,937 <1%

Personal Support Services (PSS, PSSX) 9,279 72% $80,049,368 69% * Consumers may receive more than one service ** Percentages are duplicated and rounded Figure 8 Demonstrating Results

Avoiding institutionalization “CCSP has been wonderful. I couldn’t take care of my husband, if it wasn’t for these services. I don’t want to have to put him in the nursing home. He should be able to stay at home. Getting old or sick should not mean that you can’t be home, where you want to be.” Wife caregiver of Male consumer age 67 receives PSSX Blackshear, Southern GA AAA “I have been in the nursing home and I never want to go back there. This help has given me another chance at living by myself. The aides check on me and help me do what I need to do. I have my ERS button, in case I get sick or fall. I don’t want to think about what would happen if I didn’t have CCSP.”

Male consumer age 53 receives PSS, ERS, HDM Waycross, Southern GA AAA

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CCSP Consumer Utilization of Services

*This is a duplicated consumer count. Consumers may receive more than one service.

Home Delivered Services includes consumers receiving Skilled Nursing Services Figure 9

CCSP Services Expenditures

• 3% of consumers/ families chose the Consumer Directed Personal Support Services option

• 72% of CCSP consumers utilized Personal Support Services, which accounted for 69% of total CCSP services expenditure

• 43% of CCSP consumers utilized Emergency Response Services, which only accounted for 1% of services expenditure

• Accounting for 8% of CCSP annual services expenditure, 46% of clients utilized Home Delivered Meals

• Alternative Living Services ranked second in expenditures, and accounted for 12% of CCSP Medicaid provider services costs.

PSS, 9,279

CD option PSS, 400

ERS, 5,563

HDS/SNS, 109

HDM, 5,880

ALS, 2,555

ADH, 878 OHRC, 95

CONSUMER USE OF CCSP SERVICES SFY 2012 *

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CCSP Service Provider Agencies CCSP supports local economic business development. CCSP manages, coordinates, and provides services to consumers by partnering with 549 public and private licensed CCSP enrolled businesses and agencies. CCSP recommends qualified provider agency applicants to DCH for CCSP Medicaid enrollment, and provides training to prospective service provider agencies. Provider agencies deliver services identified by the consumer’s care coordinator and approved by the primary physician.

Provider Agencies - By Service Type* Adult Day Health

65

Alternative Living Services - Family Model (2-6 beds)

24*

Alternative Living Services - Group Model (7-24 beds)

151

Consumer Direction Option / Financial Management Service

2/ 2

Emergency Response Services

13

Home Delivered Meals

35

Home Delivered Services / Skilled Nursing Services

5 / 20

Out-of-Home Respite Care Services

8

Personal Support Services

290

TOTAL

549

Some providers provide more than one service *ALS-Family Model provider agencies registered 787 family homes in SFY 2012 Figure 10 Quality Initiatives Consumer Direction In SFY 2012, 362 CCSP consumers elected the Consumer Directed Personal Support Services (CD-PSS) option. Eligible CCSP consumers have more control in organizing service resources, implementing choice in determination of how to meet their needs, and taking responsibility for planning, hiring, and managing their own Personal Support Services service staffing support and delivery. 17

Nursing Facility to Community Transition & Money Follows the Person (MFP)

In SFY 2012, 171 consumers moved into CCSP from more costly institutionalization. The Center for Medicare & Medicaid Services grant funding “Money Follows the Person” (MFP) allowed 106 consumers to enroll in CCSP. The initiative provides necessary support and services to MFP-eligible Medicaid consumers in nursing facilities who choose to transition to residences in the community. It is projected that a minimum of 100 nursing facility consumers per fiscal year will transition into the community under the Elderly and Disabled waiver over the period of the MFP grant. Additionally, 65 consumers residing in nursing facilities who chose to be in the community and who did not qualify for MFP were enrolled in the community-based CCSP. Caregiver Assessment - TCARE® (Tailored Caregiver Assessment and Referral) “If the family caregiver were no longer available, we’d see an immediate rise in nursing home use and re-hospitalization.”…Taking care of loved ones can exact a toll. Up to 70 percent of family caregivers suffer clinical levels of depression, experts say.”9 The Georgia Department of Human Services Division of Aging Services, with funding from the U.S. Administration on Aging, has concluded the research phase of an Alzheimer's Demonstration grant. The evidence-based study evaluated a caregiver assessment instrument which guides care coordinators in understanding caregiver's needs, strategically selecting and recommending services, consulting with caregivers to give them the opportunity for informed choice, and creating a care plan that caregivers will embrace and follow. TCARE® was developed by Dr. Rhonda Montgomery and colleagues at the University of Wisconsin. The University of Wisconsin published two studies on TCARE®. The first, published in The Gerontologist in May, 2011, was a longitudinal study of 97 caregivers in Georgia. Results demonstrated that caregivers in the treatment group receiving TCARE® support services experienced: A decrease in the intention to place consumers in an institutional setting (while caregivers

in the control group experienced the opposite) Lower levels of identity discrepancy in the tasks of caregiving^, decrease in stress burden*

and feelings of depression More uplifts, the positive psychological outcomes associated with care giving. A second study, just published in the Journals of Gerontology in June, 2011, with Georgia and three other states, was a longitudinal, randomized, controlled intervention study with 266 family caregivers. It found statistical significance on five measures, including two types of burden, depression, intention to place, and identify discrepancy, supporting the value of TCARE®. To date, 65 CCSP Care Coordinators have been certified in TCARE®. All 12 of Georgia's Area Agencies on Aging submitted action steps for full implementation of TCARE in their regions during the four-year SFY 2012- SFY 2015 Planning & Service Area Plan cycle. 9 What Are Family Caregivers Worth? Wichita Eagle, Anita Creamer, 7/7/2011quoting Susan Reinhard, AARP senior vice president for public policy ^ Identity Discrepancy- psychological state that accrues when there is a disparity between the care activities in which a caregiver is engaging and his/her identity standard. An example of identity discrepancy which demonstrates it is not the task, but how you feel about the task that is causing the discrepancy would be a son providing personal care for his mother. * Stress Burden- stress due to aspects of life, measured by tension, nervousness, and anxiety

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Description of CCSP Services

Client & Caregiver Quotes Care Coordination The RN care coordinator assesses the consumer’s medical, functional and social needs to determine eligibility for the CCSP and, with input from the client, caregiver, and physician develops a specific comprehensive consumer-focused plan of care for each consumer admitted to the CCSP. The care coordinator (Registered Nurse or Social Worker) establishes services for consumers with enrolled service provider agencies, refers families and consumers to other community-based and non-Medicaid services, and monitors provider services for consumers. “The program has provided [mother] with a much better quality of life than she would have had without it. After a fall, mother spent many months in a nursing home for PT. Her CCSP care coordinator was involved in the process of mother’s return to the community. She coordinated much of the support necessary for mother to continue to live in an independent setting. We will be forever grateful for the program, the program staff, and the services the program provides to keep mother in her own apartment.”

Caregiver son of Female consumer age 88 receives PSS, PSSX, MFP

Rome, Northwest GA AAA "I do not know what I would do without CCSP. From the very beginning you have been a tremendous help to me and I could not have taken over care of my sister without your assistance. You found a wonderful assisted living home for her to stay in and when it came time for her to have to move from there, you provided me with a list of CCSP assisted living homes to look at for her. You have always been nothing but pleasant and helpful. I am extremely grateful."

Daughter caregiver age 68 of Female consumer age 75 receives ALS Nicholson, Northeast GA AAA

“I think the Community Care Program is wonderful. Everyone is so nice and helpful. As my body changes and my needs grow, I know I can rely on my Case Manager and aide to meet my needs for assistance and encouragement to not give up, keep trying. I’m so appreciative for the help, support and concerns of everyone.”

Female consumer age 69 receives PSS, ERS and HDM

Gainesville, Legacy Link AAA Adult Day Health (ADH) ADH provides care in a community-based day program for consumers who are functionally or cognitively impaired. ADH provides consumers a variety of activities and services in a group setting: nursing care, special therapeutic services, personal care services, planned therapeutic activities, dietary services, transportation, and social work services. Mobile Day Care responds to needs for service of seniors living in rural areas. “The services I get at home help my mother take care of me. I love working on the computers at ADH, and it gives my mom a break when I’m there. I don’t have to call my mom all the time to help me. When I’m at the center, if I need help, the staff assists me. At home, my aide does the same. I also can talk to other people. The services at home help make things easier for my mom to take care of me. CCSP helps me be able to stay at home. I worry about my mom having to take care of me and my aide makes it easier for her to do that. Because of the services, we don’t have to pay a sitter full time to help me. I love my care coordinator. She is like family and helps me with whatever I need.”

Female consumer age 49 receives PSS, PSSX, ADH

Columbus, River Valley AAA

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Alternative Living Services (ALS) ALS provides 24-hour supervision, medically-oriented personal care, routine nursing supervision, and health-related support services in a residential setting other than the consumer's home. This service is provided in state licensed personal care homes. “I love being here, this is my home. I am not able to live alone or with my family. I have no family that cares for me anymore, and the people here are now my family. The staff sees about me and takes good care of me. I can’t ask for anything any better.”

Male consumer age 72 receives ALS

Tifton, Southern GA AAA “The program helps me feel less anxious and nervous about being alone. I know my needs are met and I feel safer here.”

Female consumer age 62 receives ALS

Central Savannah River AAA

Consumer Directed Personal Support Services option (CD-PSS) The eligible consumer hires and supervises worker(s) of choice who provide a range of PSS support services for the CCSP consumer. The consumer must also enroll in Financial Management Services (FMS): the provider agency issues worker paychecks and on behalf of the consumer adheres to federal and state tax laws.

“The Consumer Directed Care aspect of CCSP is wonderful. It is a terrible feeling to be confined to my bed all day long and be dependent on someone else for my care. With Consumer Directed Care, I am able to control my schedule and who my aides are, which allows me to still have some type of independence. This is priceless to me. Without this program, I would have no choice but to enter a nursing home, a thought I can’t bear.”

Female Consumer age 63 receives CD-PSS

Villa Rica, GA Southern Crescent AAA Emergency Response Service (ERS) ERS provides an in-home electronic support system for two-way communication between isolated consumers and a communication control center twenty-four hours a day, seven days a week. “I am hard of hearing and have very bad eye sight. I would be in a mess without [the aide] to help me bathe and get ready for the day. Having her come in and help me lets me continue doing the little things I enjoy doing, such as spending time with my great-granddaughters. I often think where I would be without the help and then I decide not to think about it. I am so thankful for my button; I had to use it the other night when I heard someone messing with my door. It gives the feeling of not being alone when I am scared. I am so grateful I have been able to stay at home and not go to that nursing home.”

Female Consumer age 84 receives PSS, ERS

Ashburn, Southern GA AAA

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Home Delivered Meals (HDM) HDM ensures improved nutrition to enhance consumer health and well-being. Consumers may receive home delivered meals only in conjunction with another CCSP service. “I am so thankful for the services I receive from CCSP. I am unable to stand on my feet to cook a meal. Receiving home delivered meals I am able to have a hot nutritious meal. I think that this has actually improved my health. I am truly blessed to have my ERS button. I have had to use my button twice this year and I really believe this button has saved my life. With the help of these services, I am able to stay in my home.”

Female consumer age 57 receives ERS, HDM

Alma, Southern GA AAA

Home Delivered Services (HDS) HDS Medicaid Home Health Services (HHS) provides traditional home health on an intermittent basis to consumers in their homes. Services include skilled nursing; physical, speech and occupational therapy; home health aide and medical social services. Out-of-Home Respite Care (OHRC) OHRC provides temporary relief for the individual(s) normally providing care in a setting outside of home.

Personal Support Services (PSS) PSS provides a range of support services for CCSP consumers. Services include activities such as the provision of assistance and support with basic personal care needs, and stand-by assistance or supervision of consumers with inability to perform activities such as feeding, dressing, bathing, toileting, transferring or walking, as well as assistance with client meal preparation, light housekeeping and running essential errands. "I rely on the help of the CCSP aide to help me be fed, bathed, and dressed. My aide also assists me from getting to and from doctor appointments since I have to carry around my oxygen tank, which makes it difficult to breathe. I would be confined to a nursing home without the help of CCSP and I am very thankful for the program"

Female Consumer age 56 receives PSSX, ERS, HDM

Newnan, GA Southern Crescent AAA

Personal Support Services - Extended (PSSX) PSS-X provides personal support services in a home setting that includes respite care for the full time caregiver over an extended period of time. “The CCSP program has enhanced our lives by allowing me to continue doing some of the things that are important without sacrificing my daughter’s care. The services allow my family the time to do outings together and not worry whether my daughter is being taken care of. CCSP was a GOD-send especially when I was still working. The program gave me the years of support I needed before I could retire.”

Caregiver mother age 68 of Female consumer age 49 receives PSSX

Columbus, River Valley AAA

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Division of Aging Services Community Care Services Program

“A partner in the Aging Network”

(404) 657 – 5307 FAX (404) 657 – 5251

Two Peachtree St., N.W., 33rd Floor Atlanta, GA 30303 – 3142

TOLL FREE DAS # 1-866-55AGING http://aging.dhr.georgia.gov